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Subject:
From:
Sara Bernard <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Tue, 22 Oct 2002 20:04:23 +0200
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"And then we all went to a national meeting to talk about the dangers of
jaundice .  .  .  This is so frightening as to be laughable."

Jay, I guess you have read the paper by Bertini this year; but just in case
(and for those who haven't - it's a good read and free online!):

http://www.pediatrics.org/cgi/content/abstract/107/3/e41
PEDIATRICS Vol. 107 No. 3 March 2001, p. e41
ELECTRONIC ARTICLE:
Is Breastfeeding Really Favoring Early Neonatal Jaundice?
Received Nov 1, 1999; accepted Nov 15, 2000.
Giovanna Bertini, Carlo Dani, Michele Tronchin, and Firmino F. Rubaltelli
From the Department of Critical Care Medicine and Surgery, Section of
Neonatology, University of Florence School of Medicine, Florence, Italy.
Objective.  The purpose of this study was to evaluate the development of
significant hyperbilirubinemia in a large unselected newborn population in a
metropolitan area with particular attention to the relationship between type
of feeding and incidence of neonatal jaundice in the first week of life.
Study Design.  A population of 2174 infants with gestational age 37 weeks
was prospectively investigated during the first days of life. Total serum
bilirubin determinations were performed on infants with jaundice. The
following variables were studied: type of feeding, method of delivery,
weight loss after birth in relationship to the type of feeding, and maternal
and neonatal risk factors for jaundice. Statistical analyses were performed
using the z test for parametric variables and the t test for nonparametric
variables. In addition, the multiple logistic regression allows for the
estimation of the role of the individual characteristics in the development
of hyperbilirubinemia. Data concerning serum bilirubin peak distribution in
jaundiced newborns were analyzed using a single and a double Gaussian best
fit at least squares. The t test was performed to compare 2 values (high and
low) of the serum bilirubin peak in breastfed and supplementary-fed infants
with those in bottle-fed infants.
Results.  The maximal serum bilirubin concentration exceeded 12.9 mg/dL (221
µmol/L) in 112 infants (5.1%). The study demonstrated a statistically
significant positive correlation between patients with a total serum
bilirubin concentration >12.9 mg/dL (221 µmol/L) and supplementary feeding;
oppositely, breastfed neonates did not present a higher frequency of
significant hyperbilirubinemia in the first days of life. However, best
Gaussian fitting of our data suggests that a small subpopulation of
breastfed infants have a higher serum bilirubin peak than do bottle-fed
infants. Newborns with significant hyperbilirubinemia underwent a greater
weight loss after birth compared with the overall studied population, and
infants given mixed feeding lost more weight than breastfed and formula-fed
newborns, indicating that formula has been administered in neonates who had
a weight loss beyond a predetermined percentage of birth weight. Significant
hyperbilirubinemia was also strongly associated with delivery by vacuum
extractor, some perinatal complications (cephalohematoma, positive Coombs'
test, and blood group systems of A, AB, B, and O [ABO] incompatibility) and
Asian origin. Multiple logistic regression analysis shows that supplementary
feeding, weight loss percentage, ABO incompatibility, and vacuum extraction
significantly increase the risk of jaundice, while only cesarean section
decreases the risk.
Conclusion.  The present study confirms the important role of fasting in the
pathogenesis of neonatal hyperbilirubinemia, although breastfeeding per se
does not seem related to the increased frequency of neonatal jaundice but to
the higher bilirubin level in a very small subpopulation of infants with
jaundice. In fact, in the breastfed infants, there is a small subpopulation
with higher serum bilirubin levels. These infants, when starved and/or
dehydrated, could probably be at high risk of bilirubin encephalopathy.  Key
words:  newborn infant, hyperbilirubinemia, neonatal jaundice.

Sara Bernard
The Netherlands
feeling very poorley with a strep. throat :-(

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